Changes in surgical therapy for Crohn's disease over 33 years: a prospective longitudinal study

Introduction Changes in surgery for Crohn's disease were analyzed in a single institution over a period of 33 years. Materials and methods The data of all patients undergoing abdominal surgery for Crohn's disease between 1970 and 2002 were collected prospectively in an electronic database. The study period was divided into three periods of 11 years, each (group 1, 1970 - 1980; group 2, 1981 - 1991; group 3, 1992 - 2002). Results There was an increase in patients' age at time of hospital admission from 32.0 +/- 0.9 to 32.4 +/- 0.5 and 37.7 +/- 0.7 years, in the duration of disease from 4.9 +/- 0.3 to 7.3 +/- 0.3 and 8.8 +/- 0.5 years, and in the number of drug-induced remissions before surgery from 3.1 +/- 0.5 to 6.1 +/- 0.2 and 4.9 +/- 0.3 in groups 1, 2, and 3, respectively (p < 0.01). The rates of elective surgery compared to urgent or emergency surgery increased from 69.5 to 81.4 and 80.9% in the corresponding groups (p < 0.01). A significant decrease in hospital mortality was observed. The analysis of Crohn's complications demanding surgery revealed a significant increase of rates of stenosis and subileus. Furthermore, there was a significant increase in serious acute complications like free bowel perforations and peritonitis. Conclusion Improved medical treatment may lead to higher rates of elective operations. However, prolonged conservative treatment may also increase the number of serious complications before surgery. Therefore, a multidisciplinary approach with early involvement of the surgeon is important to avoid any delay in indication to surgery.